Provider Demographics
NPI:1801385828
Name:GOLDEN YEARS RENOVATIONS LLC
Entity Type:Organization
Organization Name:GOLDEN YEARS RENOVATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:VINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-236-1988
Mailing Address - Street 1:2501 CLUBLAKE TRL
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-4005
Mailing Address - Country:US
Mailing Address - Phone:469-236-1988
Mailing Address - Fax:
Practice Address - Street 1:15922 ELDORADO PKWY STE 500-1592
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-5836
Practice Address - Country:US
Practice Address - Phone:469-236-1988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies